As I sat in our post-Match malpractice lecture, my blood simmered and then boiled as an MD/JD reviewed aspects of the medico-legal system and statistics about how often my newly matched classmates and I would all be sued. Just the threat of a malpractice suit requires hundreds of thousands of dollars of malpractice insurance, not to mention a robust emotional toll. The celebratory mood that had permeated the class since Match gave way to a somber silence as my classmates and I filed out of the lecture hall.
As the child of a private practice ob/gyn, I was born into a relationship with the medical system, and as a result, I felt prepared to face the most frustrating aspects of this profession. I knew about rounding, pagers, call, and consults before I learned algebra. Malpractice insurance was a dinner table topic, something familiar. If I was having a visceral reaction to the lecture, how must my friends who had matched into a high-risk specialty without a physician parent feel? In the weeks following Match Day, I reflected on the role of malpractice insurance and the threat of lawsuits in my life.
When I was about 8 years old, my family returned from a trip to Disney World to a message on the answering machine that would change our collective lives. My mom pressed the blinking red voicemail button releasing a prattle of voices. She skipped over most of them until we heard the unmistakable voice of the hospital CEO where my dad worked. We sat, stunned, as he explained that my dad’s hospital privileges had been suspended while he was on vacation because he did not have malpractice insurance. At the time, Florida allowed private practice clinicians to set aside money for possible litigation instead of malpractice insurance. My parents had been paying over $100,000 a year for malpractice insurance even though my dad had never been sued, so they elected to forgo insurance and establish a fund instead. When the hospital refused to accept this alternative, overnight, my dad lost the ability to perform his job without actually losing his job. As requirements for individual hospital privileges are determined by each hospital and not by the state laws, he had no choice but to purchase insurance or risk leaving his patients to deliver with a new ob/gyn. If he spent time negotiating with the hospital administration, his family would have to go without the income they relied on while they reached an agreement.
A year later, we moved so my dad could join a group practice. This decision was driven, at least in part, by the climbing cost of malpractice insurance and the challenges private practitioners faced in obtaining affordable insurance. Unfortunately, this problem is not unique to my father. Malpractice insurance and the threat of malpractice litigation affect many physicians’ choice of practice setting, location, or scope of practice. The American College of Obstetricians and Gynecologists reported in 2015 that 50% of surveyed ob/gyns changed aspects of their practice out of fear of litigation, and nearly 40% changed their practice due to unaffordable or inaccessible malpractice insurance. Some, like my dad, transitioned from private to group practice when the cost of malpractice insurance became unsustainable. Others may limit their practice to gynecology or avoid high-risk obstetric patients. Though only about 2% of physicians report being sued yearly, over 30% report facing a malpractice suit at some point in their careers. The likelihood of being sued for malpractice is much higher for surgeons, with general surgeons and obstetricians facing the highest burden. Neurosurgeons and obstetricians have the highest payouts in cases where plaintiffs are awarded damages. Consequently, these clinicians also pay more for malpractice insurance.
The threat of litigation also may dissuade medical students from pursuing higher risk specialties. Despite being proud of his career, my father strongly discouraged me from pursuing ob/gyn as a specialty because of the emotional and financial risks of malpractice lawsuits in the field. A 2007 survey study of Floridian medical students showed that 27% of students who considered ob/gyn but chose a different specialty listed fear of being sued as one of their top two reasons for deciding against ob/gyn.
My medical school included discussions about malpractice litigation to prepare us to write detailed documentation as residents and ensure we built good habits to protect our future practice. While well-intentioned, this education is too little too late. Medical schools do students a disservice if they do not expose them to medico-legal statistics that can help them make informed decisions about their future specialties prior to the Match. There is now a nearly constant discussion of burnout in medicine. While the love of a specialty and patient population is crucial in a student’s specialty decision, other factors like the threat of litigation can significantly impact mental health and physician well-being. The idea of selecting a specialty for an “ignoble” reason like better quality of life or lower threat of lawsuits has historically been taboo. Consequently, discussions about the differing lifestyles and medico-legal realities of each specialty are late, casual, or nonexistent. It is important to provide medical students, especially first-generation students, with clear, quality information about the realities of litigation throughout their training so that they understand how to navigate this issue.
When I chose a career in medicine I knew that I would lose sleep over patient outcomes. Though the thought frustrates me even now, I also knew that I would lose another few hours due to fear of lawsuits. The fact that such an ugly thing holds so much power makes me feel helpless, but I am lucky to have been able to weigh malpractice litigation into my choice of specialty. I hope that my classmates who left our capstone lecture walked out without regrets. I hope they never change their practice out of fear of litigation, and most of all, I hope that other medical students get to grapple with these issues before they make one of the biggest decisions of their lives.
The AMA summarized several articles on medical malpractice litigation and various reform measures by state here. This is a good place to start for medical students who want to review this information.
How has the threat of litigation affected your practice or your choice of specialty? Share in the comments!
Dr. Allison Oliva is an otolaryngology resident in Miami, FL. When she’s not at work, she enjoys walking along the water with her fiancé, drinking coffee, reading, and watching Miami Hurricanes football. Dr. Oliva is a 2024–2025 Doximity Op-Med Fellow.
Illustration by April Brust
